PART 1 - Notes on Completion - Home | Central Bank of Ireland



Application Form for Authorisation as a Retail Intermediary - B FORMUnder the:Investment Intermediaries Act 1995 (IIA)European Union (Insurance Distribution) Regulations 2018 (IDR)European Union (Consumer Mortgage Credit Agreements) Regulations 2016 (CMCAR)Consumer Credit Act 1995 (CCA)July 2020Table of Contents TOC \o "1-3" \h \z \u PART 1 - Notes on Completion PAGEREF _Toc44083730 \h 3PART 2 - Applicability of this Application Form PAGEREF _Toc44083731 \h 7PART 3 - Applicant Information PAGEREF _Toc44083732 \h 8PART 4 - Applicant Legal Status PAGEREF _Toc44083733 \h 104.1 Company Applicant PAGEREF _Toc44083734 \h 104.2 Sole Trader Applicant PAGEREF _Toc44083735 \h 104.3 Partnership Applicant PAGEREF _Toc44083736 \h 10PART 5 - Authorisation Type PAGEREF _Toc44083737 \h 125.1 Investment Intermediaries Act 1995 (IIA) Application PAGEREF _Toc44083738 \h 125.2 European Union (Insurance Distribution) Regulations 2018 (IDR) Application PAGEREF _Toc44083739 \h 135.3 European Union (Consumer Mortgage Credit Agreements) Regulations 2016 (CMCAR) Application PAGEREF _Toc44083740 \h 175.4 Consumer Credit Act 1995 (CCA) Application PAGEREF _Toc44083741 \h 18PART 6 - Business Plan PAGEREF _Toc44083742 \h 206.1 Business Strategy & Activities PAGEREF _Toc44083743 \h 206.2 Client Projections PAGEREF _Toc44083744 \h 216.3 Financial Details PAGEREF _Toc44083745 \h 22PART 7 - Programme of Operations PAGEREF _Toc44083746 \h 237.1 Structure / Governance and Staffing Arrangements PAGEREF _Toc44083747 \h 237.2 Minimum Competency Code 2017 (MCC) & Minimum Competency Regulations 2017 (MCR) PAGEREF _Toc44083748 \h 247.3 Professional Indemnity Insurance (PII) PAGEREF _Toc44083749 \h 257.4 Compliance / Internal Audit PAGEREF _Toc44083750 \h 267.5 Qualifying Shareholders PAGEREF _Toc44083751 \h 287.6 Close Links PAGEREF _Toc44083752 \h 307.7 Outsourcing PAGEREF _Toc44083753 \h 317.8 IT Systems, Website and Business Continuity Planning PAGEREF _Toc44083754 \h 327.9 Regulatory Background PAGEREF _Toc44083755 \h 327.10 Online Annual Return and Industry Funding Levy PAGEREF _Toc44083756 \h 347.11 Investor Compensation Company DAC (ICCL) PAGEREF _Toc44083757 \h 347.12 Passporting PAGEREF _Toc44083758 \h 34PART 8 - Declaration PAGEREF _Toc44083759 \h 36PART 1 - Notes on CompletionTHE APPLICANT SHOULD NOT COMPLETE THIS APPLICATION FORM UNTIL IT HAS READ AND IS FAMILIAR WITH: The “Guidance Note on Completing an Application Form for Authorisation as a Retail Intermediary – B FORM” (the Guidance Note) (many terms used in this application form are described in the Guidance Note); and The relevant legislation under which the applicant is seeking authorisation as a retail intermediary i.e., the:Investment Intermediaries Act 1995 (IIA); and/orEuropean Union (Insurance Distribution) Regulations 2018 (IDR); and/orEuropean Union (Consumer Mortgage Credit Agreements) Regulations 2016 (CMCAR); and/or Consumer Credit Act 1995 (CCA), as appropriate. This application form should ONLY be completed by an applicant that satisfies the following criteria. The applicant:Does not propose to act only as a tied insurance intermediary and/or an IIA tied agent within 12 months of authorisation; andSatisfies at least one of the following criteria:Proposes to have an organisational structure that includes branches, tied insurance intermediaries, IIA tied agents, sub-brokers or agents within 12 months of authorisation; orProposes to operate as a Managing General Agent (MGA) within 12 months of authorisation; orProposes to passport its services into other Member States within 12 months of authorisation; orProposes to provide services to 2,500 or more consumers based on:a projected average number of consumers in years 1-3 post authorisation; andincluding direct and indirect consumers of the applicant (i.e., including consumers of branches, tied insurance intermediaries, IIA tied agents, sub-brokers and agents of the applicant).An application form must be submitted in typed searchable format (with the exception of the signatures required in the Declaration being made in Part 8 of the application form).All questions in each section of the application form that are relevant to the applicant must be answered. Any questions that have a ‘YES/NO’ or ‘YES/NO/N/A’ box should be completed by the applicant with a ‘YES’, ‘NO’ or ‘N/A’ answer, as appropriate. Do not leave any blank spaces in sections of the application form that are relevant to the applicant. If the applicant cannot answer a question(s) asked or provide the information or documentation requested, it should include a cover letter with its application submission explaining the rationale for being unable to answer the relevant question(s) or provide the information or documentation requested.Any questions that require a ‘Document Reference’ should be completed by inputting a reference to the document where a response to that question has been provided. If the question is in an applicable section but is not applicable “N/A” should be inputted. Applicants must ensure that document referencing is fully completed throughout this application form in the boxes provided. Document references should match the relevant application form question number e.g. the document provided in response to question 3.8 should be referenced as Document 3.8. Any questions that require a ‘Type Answer’ should be completed by typing a response directly into the application form. Space is provided to type responses to these questions directly into the application form and Declaration. Additional rows may be added by the applicant, if required to complete its response to a question, but the structure and content of the application form and Declaration must not be deleted or amended in any other manner. If the question is in an applicable section but is not applicable “N/A” should be inputted.The applicant should note that any information or documentation provided with its application submission that has not been requested as part of the application process will not be reviewed.The applicant should ensure that it has read and understands the Declaration being made in Part 8 of the application form. This Declaration should be fully completed, signed and dated.An electronic copy of the completed application form and all required supporting documentation should be submitted in electronic format to the Central Bank via our secure file transfer system by requesting access from RIAuthorisations@centralbank.ie. Physical copies of the completed application form and all required supporting documentation are not required to be submitted. The applicant is obliged to inform the Central Bank of any material changes to the information provided in the application submission, in a timely manner, during or after the application process. The Central Bank may seek further information or clarification in respect of the information provided by the applicant in the application submission for the purpose of assessing and reaching a determination in respect of the application. The Central Bank applies a risk based approach in assessing applications and the nature, scale and complexity of the applicant will determine the extent to which any further information or clarification is sought from an applicant. The Central Bank may also decide to interview key members of the senior management of an applicant before deciding whether to grant an authorisation. The Central Bank will only grant an authorisation to an applicant if it is satisfied that the applicant has demonstrated that it meets the relevant authorisation requirements.The applicant should ensure that all information provided in the application submission is accurate and complete. All information which might reasonably be considered relevant for the purpose of the application must be disclosed. If not, the application may be refused or the application process may be delayed.An application submission will only progress to the Assessment Phase of the application process when the following have been received:A fully completed application form (including all required supporting documentation);An Individual Questionnaire (IQ) in respect of each person proposed to hold a Pre-Approval Controlled Function (PCF) role within the applicant (to be provided when the applicant receives a request to submit the relevant IQ(s) via the Online Reporting System (ONR); and A Garda Vetting Invitation Form (including proof of identify) and Vetting Application Form (where applicable and when the applicant is requested to submit these forms). For further information on the retail intermediary authorisation process and guidance material to assist applicants in completing IQs and the Garda Vetting Invitation Form and Vetting Application Form, refer to the relevant page(s) on the Central Bank website (here) and in relevant sections of ‘Completing and Submitting an Individual Questionnaire’. An incomplete application may be returned to the applicant and the applicant will be advised that the application does not contain sufficient material to be progressed. The legislative and regulatory requirements referred to in this application form are not exhaustive and the applicant should ensure that it is familiar with, and in a position to comply with, all the relevant legislative and regulatory requirements applicable to its proposed regulated activities, should it be granted an authorisation by the Central Bank.The Central Bank may process personal data provided by the applicant in order to fulfil its statutory functions or to facilitate its business operations. Any personal data will be processed in accordance with the requirements of data protection legislation. Any queries concerning the processing of personal data by the Central Bank may be directed to dataprotection@centralbank.ie. A copy of the Central Bank’s Data Protection Notice is available at centralbank.ie/fns/privacy-statement.Any queries in relation to this application form should be sent to RIAuthorisations@centralbank.ieIMPORTANT NOTICE – FALSE OR MISLEADING INFORMATION The applicant must ensure that ALL information provided to the Central Bank in relation to the application submission is accurate and complete. The provision of false or misleading information in respect of an application submission is a significant factor to which the Central Bank will have regard, which may adversely affect your application:In particular, in respect of an application for authorisation as an authorised investment business firm (referred to herein as an investment intermediary) under the IIA: the provision of false or misleading information or statements by the applicant is a criminal offence punishable by, on summary conviction, a fine and/or a maximum of 12 months’ imprisonment and, on conviction on indictment, a fine and/or a maximum of 10 years’ imprisonment; and in the event that authorisation is granted, the Central Bank may subsequently revoke the authorisation on the ground that the authorisation was obtained by making statements, or providing information, that the applicant for authorisation knew or ought to have known were false or misleading. In particular, in respect of an application for registration as an insurance, reinsurance or ancillary insurance intermediary under the IDR: the provision of a notification by the applicant, which is false or misleading in a material particular or which the applicant does not believe to be true, is a criminal offence punishable by, on summary conviction, a fine and/or a maximum of 12 months’ imprisonment and, on conviction on indictment, a fine and/or a maximum of 3 years’ imprisonment; and in the event that registration is granted, the Central Bank may subsequently withdraw the registration of, and remove from the Register, an insurance, reinsurance or ancillary insurance intermediary, where it was obtained by means of a false or misleading representation. In particular, in respect of an application for authorisation as a mortgage credit intermediary under the CMCAR: the wilful provision of any information, which is false or misleading, is a criminal offence punishable by, on summary conviction, a fine and/or a maximum of 12 months’ imprisonment and, on conviction on indictment, a fine and/or a maximum of 3 years’ imprisonment; and in the event that authorisation is granted, the Central Bank may subsequently suspend the operation of, or revoke, the authorisation where it was obtained by the provision of false or misleading statements by the applicant or any other irregular means.In particular, in respect of an application for authorisation as a mortgage intermediary under the CCA a person shall not wilfully give any information, which is false or misleading. PART 2 - Applicability of this Application FormAll applicants must complete all questions set out belowRespond to the questions below to confirm that the applicant satisfies the criteria to use this application form:2.1Confirm the legislation under which the applicant is seeking authorisation:(a)Investment Intermediaries Act 1995 (IIA)[Yes/No](b)European Union (Insurance Distribution) Regulations 2018 (IDR)[Yes/No](c)European Union (Consumer Mortgage Credit Agreements) Regulations 2016 (CMCAR)[Yes/No](d)Consumer Credit Act 1995 (CCA) [Yes/No]2.2Confirm that, within 12 months of authorisation, the applicant proposes to have an organisational structure that includes branches, tied insurance intermediaries, IIA tied agents, sub-brokers or agents[Yes/No]2.3Confirm that, within 12 months of authorisation, the applicant proposes to operate as a Managing General Agent (MGA)[Yes/No]2.4Confirm that, within 12 months of authorisation, the applicant proposes to provide insurance distribution and/or reinsurance distribution services and/or mortgage credit intermediation from a branch established in another Member State (i.e., on a Freedom of Establishment basis) [Yes/No]2.5Confirm that, within 12 months of authorisation, the applicant proposes to provide insurance distribution and/or reinsurance distribution services and/or mortgage credit intermediation on a cross border basis in another Member State (i.e., on a Freedom of Services basis)[Yes/No]2.6Confirm that the applicant proposes to provide services to 2,500 or more consumers, based on a projected average number of consumers in years 1-3 post authorisation, including direct and indirect consumers of the applicant (i.e., including consumers of branches, tied insurance intermediaries, IIA tied agents, sub-brokers and agents of the applicant)[Yes/No]2.7Confirm that, within 12 months of authorisation, the applicant does not propose to act only as a tied insurance intermediary and/or as an IIA tied agent[Yes/No]If NONE of questions 2.2 – 2.6 above have been answered “yes” OR QUESTION 2.7 HAS BEEN ANSWERED “NO”, the applicant should NOT COMPLETE this application form as it does not satisfy the criteria to do so. The applicant SHOULD CONSIDER WHETHER IT MEETS THE CRITERIA TO complete the “Application Form for Authorisation as a Retail Intermediary – a FORM” which can found here.PART 3 - Applicant InformationAll applicants must complete all questions set out below3.1Full legal name of the applicant[Type Answer]3.2Previous legal name(s) of the applicant (if applicable)[Type Answer]3.3Legal status of the applicant[Type Answer]3.4Trading name(s) the applicant will use, if different from response to question 3.1 above, and relevant Irish CRO Business Name Registration Number(s)[Type Answer]3.5Head Office of the ApplicantRegistered Office of the Applicant12Principal Place of Business of the Applicant12Postal Address[Type Answer][Type Answer][Type Answer]Telephone Number[Type Answer][Type Answer][Type Answer]Email Address(es)[Type Answer][Type Answer][Type Answer]Website Address(es)[Type Answer][Type Answer][Type Answer]3.6Confirm if the applicant, either on the date of authorisation or within the first 12 months of authorisation, intends to establish other places of business other than its principal place of business set out in response to question 3.5 above[Yes/No]3.7If yes to question 3.6 above, provide details of the other places of business the applicant proposes to establish, their locations and the activities proposed to be conducted in those other places of business [Type Answer]3.8Confirm if the applicant, either on the date of authorisation or within the first 12 months of authorisation, intends to establish one or more websites in respect of its regulated activities[Yes / No]3.9If yes to question 3.8 above, confirm that any websites established by the applicant, if granted an authorisation, will comply with the applicable regulatory requirements set out in the Consumer Protection Code 2012 and the IIA and/or IDR and/or CMCAR and/or CCA (where relevant), and in particular that any such websites will contain the correct regulatory disclosures required pursuant to Chapter 4 of the Consumer Protection Code 2012 and will be clearly segregated between regulated and unregulated activities[Yes / No / N/A]3.10Provide the contact details of the following persons:Individual who will accept service of any documents in respect of the application submission and of any future correspondence issued to the applicant if it is granted an authorisation Individual who will be responsible for accepting login details for the purposes of submitting IQs in respect of proposed PCF role holders in the applicant via the Central Bank’s ONRWithin the ApplicantThird PartyWithin the Applicant OnlyName[Type Answer][Type Answer][Type Answer]Position in the Applicant / Relationship to the Applicant[Type Answer][Type Answer][Type Answer]Postal Address[Type Answer][Type Answer][Type Answer]Telephone Number[Type Answer][Type Answer][Type Answer]Email Address[Type Answer][Type Answer][Type Answer]3.11Confirm whether the applicant already have an existing System Administrator set up on the ONR[Yes / No / N/A]3.12If yes to question 3.11 confirm that you have identified the existing System Administrator in response to question 3.10 (b) or where the applicant wishes to change their System Administrator, please contact onlinereturns@centralbank.ie to request such as change[Yes / No / N/A]3.13Confirm that the Central Bank has the applicant’s permission to liaise with the third party named in response to question 3.10 a) above to seek further information or clarification in respect of the information or documentation included in the application submission[Yes/No / N/A]PART 4 - Applicant Legal StatusAll applicants must complete Section 4.1, 4.2 or 4.3 set out below 4.1 Company Applicant4.1.1Confirm that the scope of the applicant’s Constitutional Document(s) is/are sufficiently wide to permit it to conduct the proposed retail intermediary activities and any other proposed activities[Yes/No]4.1.2Provide the applicant’s Irish CRO Registered Number [Type Answer]4.1.3Provide the Tax Reference Number from the applicant’s current Irish Revenue Tax Clearance Certificate[Type Answer]4.1.4[I/We], [Insert Name of Directors(s) making declaration] confirm that to the best of [my/our] knowledge and belief, and having conducted appropriate due diligence, that:(a)The total assets of [Insert Legal Name of Applicant] exceeds the total liabilities of [Insert Legal Name of Applicant] as at the date of authorisation, and for the first 12 months of authorisation, and that goodwill and other intangible assets have been excluded in the calculation of the assets of [Insert Legal Name of Applicant][Yes/No](b)[Insert Legal Name of Applicant] is in a positive cash flow position, and that the applicant is not currently aware of any circumstances that would cause this position to change within the next 12 months[Yes/No]4.1.5[I/We] confirm that [Insert Legal Name of Applicant] will notify the Central Bank immediately if at any time the financial circumstances of [Insert Legal Name of Applicant] change to an extent which would render it unable to answer ‘Yes’ in response to questions 4.1.4(a) or (b) above[Yes/No]4.2 Sole Trader Applicant4.2.1Provide the Tax Reference Number from the applicant’s current Irish Revenue Tax Clearance Certificate[Type Answer]4.2.2I, [Insert Legal Name of Applicant] confirm that to the best of my knowledge and belief, and having conducted appropriate due diligence, that:(a)The total of the personal and business assets of [Insert Legal Name of Applicant] exceeds the total of the personal and business liabilities of [Insert Legal Name of Applicant] as at the date of authorisation, and for the first 12 months of authorisation, and that goodwill and other intangible assets have been excluded in the calculation of the personal and business assets of [Insert Legal Name of Applicant][Yes/No](b)[Insert Legal Name of Applicant] is in a positive cash flow position, and that the applicant is not currently aware of any circumstances that would cause this position to change within the next 12 months[Yes/No]4.2.3I confirm that [Insert Legal Name of Applicant] will notify the Central Bank immediately if at any time the financial circumstances of [Insert Legal Name of Applicant] change to an extent which would render it unable to answer ‘Yes’ in response to questions 4.2.2(a) or (b) above[Yes/No]4.3 Partnership Applicant4.3.1Confirm that the scope of the applicant’s Partnership Agreement is sufficiently wide to permit it to conduct the proposed retail intermediary activities and any other proposed activities[Yes/No]4.3.2Provide the Tax Reference Number from the applicant’s current Irish Revenue Tax Clearance Certificate [Type Answer]4.3.3I, [Insert Legal Name of Partner(s) making declaration], confirm that to the best of [my/our] knowledge and belief, and having conducted appropriate due diligence, that:(a)The total of the personal and business assets of [Insert Legal Name of each Partner] exceeds the total of the personal and business liabilities of [Insert Legal Name of each Partner], as at the date of authorisation, and for the first 12 months of authorisation, and that goodwill and other intangible assets have been excluded in the calculation of the personal and business assets of [Insert Legal Name of each Partner][Yes/No](b)[Insert Legal Name of each Partner] is in a positive cash flow position, and that the applicant is not currently aware of any circumstances that would cause this position to change within the next 12 months[Yes/No]4.3.4[I/We] confirm that [Insert Legal Name of each Partner] will notify the Central Bank immediately if at any time the financial circumstances of [Insert Legal Name of each Partner] change to an extent which would render it unable to answer ‘Yes’ in response to questions 4.3.3(a) or (b) above[Yes/No]PART 5 - Authorisation TypeAll applicants must complete Section 5.1 and/or 5.2 and/or 5.3 and/or 5.4 set out below5.1 Investment Intermediaries Act 1995 (IIA) Application5.1.1If applying for authorisation under the IIA, confirm if the applicant intends to:(a)Provide investment advice[Yes/No](b)Receive and transmit orders in relation to investment instruments on behalf of investors[Yes/No](c)Act as a Deposit Agent[Yes/No](d)Act as a Deposit Broker[Yes/No]5.1.2If yes to questions 5.1.1(a) and/or 5.1.1(b) above, indicate in the table below the investment instruments in respect of which the applicant proposes to provide investment advice and/or receive and transmit orders. If yes to questions 5.1.1(b) and/or 5.1.1(c) and/or 5.1.1(d) above, indicate in the table below to whom these orders will be transmitted (i.e., the Product Producers with whom the applicant will hold a Letter of Appointment):Investment InstrumentsInvestment AdviceReceiveand Transmit OrdersName of Product Producer Regulator of Product Producer (a)Shares in a company that is listed on a stock exchange[Yes/No][Yes/No][Type Answer][Type Answer](b)Bonds that are listed on a stock exchange[Yes/No][Yes/No][Type Answer][Type Answer](c)Prize Bonds[Yes/No][Yes/No][Type Answer][Type Answer](d)Relevant Collective Investment Scheme Instruments (within the meaning of Section 4(2)(a) to (c) of the IIA)[Yes/No][Yes/No][Type Answer][Type Answer](e)Tracker Bonds (other than those offered by an insurance undertaking) [Yes/No][Yes/No][Type Answer][Type Answer](f)Personal Retirement Savings Accounts (within the meaning of the Pensions Act, 1990)22 other than those offered by an insurance undertaking [Yes/No][Yes/No][Type Answer][Type Answer](g)Deposits[Yes/No][Yes/No][Type Answer][Type Answer]5.1.3Confirm that the applicant will have a Letter of Appointment in place with each Product Producer (signed by the applicant and the relevant Product Producer) identified in response to question 5.1.2 above prior to the applicant acting as an intermediary with regard to that Product Producer [Yes/No]5.1.4Confirm that the applicant will not hold clients’ funds or securities in such a way as to become a debtor to its clients, as prohibited by Section 26(1)(c) of the IIA[Yes/No]5.1.5Confirm that the applicant has reviewed and assessed the requirements set out in the Handbook of Prudential Requirements for Investment Intermediaries, and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with those requirements on the date of authorisation and on an on-going basis[Yes/No]5.1.6Describe the human and financial resources to be devoted to the induction and training of the staff and senior members of the applicant in the first 12 months of authorisation[Document Reference]5.1.7 IIA Wholesale Brokers(a)Confirm if the applicant proposes to act as a Wholesale Broker i.e., to appoint other investment intermediaries[Yes / No / N/A](b)If yes to question 5.1.7(a) above, confirm that the applicant has reviewed and assessed the requirements imposed on Product Producers under Section 6.5 of the Handbook of Prudential Requirements for Investment Intermediaries, and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place in relation to the appointment and on-going oversight of appointed investment intermediaries to ensure that the applicant complies with those requirements on the date of authorisation and on an on-going basis[Yes / No / N/A](c)If yes to question 5.1.7(a) above, [I/We] confirm that [Insert Legal Name of Applicant] will have a minimum shareholders’ funds (or in the case of an unincorporated body of persons, a sole trader or partnership, a positive capital account) of €50,000 in place, in compliance with Requirement 3.3 of the Handbook of Prudential Requirements for Investment Intermediaries, as at authorisation date[Yes / No / N/A](d)[I/We] confirm that [Insert Legal Name of Applicant] will notify the Central Bank immediately if at any time the financial circumstances of [Insert Legal Name of Applicant] change to an extent which would render it unable to answer ‘Yes’ in response to question 5.1.7(c) above[Yes / No / N/A](e)If yes to question 5.1.7(a) above, provide details of the due diligence checks conducted by the applicant prior to the appointment of an intermediary, highlighting the key areas that are assessed and the reasons that would cause the applicant to reject an application for appointment from a proposed intermediary, and the on-going monitoring the applicant will perform in respect of appointed intermediaries, describing the activities to be conducted[Document Reference]5.2 European Union (Insurance Distribution) Regulations 2018 (IDR) Application5.2.1If applying for authorisation under the IDR, confirm if the applicant intends to act as: (a)An Insurance Intermediary[Yes/No](b)An Ancillary Insurance Intermediary[Yes/No](c)A Reinsurance Intermediary[Yes/No]5.2.2Confirm if the proposed regulated activities of the applicant relate to:(a)Life Assurance Protection Policies (i.e., any product underwritten by a Life Insurance Undertaking)[Yes/No](b)General Insurance Policies (i.e., any product underwritten by a General Insurance Undertaking)[Yes/No](c) Loss Assessing / Claims Handling[Yes/No](d)Reinsurance Distribution[Yes/No](e)Other [Yes/No]5.2.3If yes to question 5.2.2(a) above, confirm if the applicant will be undertaking insurance distribution in relation to insurance-based investment products[Yes / No / N/A]5.2.4If yes to question 5.2.2(e) above, provide a description of the other type of activity below[Type Answer]5.2.5Provide details of the person(s) within the applicant who will be responsible for the insurance or reinsurance distribution business, as provided for in Regulation 6(3)(b) of the IDR:Name[Type Answer][Type Answer]Position in the Applicant[Type Answer][Type Answer]Email Address[Type Answer][Type Answer]Phone Number[Type Answer][Type Answer]5.2.6Confirm that: (a)The person(s) proposed in response to question 5.2.5 above will hold a PCF role within the applicant and will be compliant with the requirements of the Minimum Competency Code 2017 as at authorisation date[Yes/No](b)The applicant has assessed and is satisfied that the person(s) identified in response to question 5.2.5 above has (have) the appropriate skills and experience to assume this responsibility as provided for in Regulation 20 of the IDR[Yes/No]5.2.7Provide details of the identity of the insurance undertakings, insurance intermediaries and/or ancillary insurance intermediaries in respect of which the applicant intends to distribute insurance products in the first 12 months post authorisation below:Legal NameTrading NamePostal AddressEmail AddressPhone Number[Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer]5.2.8If yes to question 5.2.1(a) above (i.e., the applicant intends to act as an insurance intermediary), confirm that the applicant has reviewed and assessed the requirements set out in Regulations 30, 31 and 34 to 37 of the IDR, and that, where relevant, it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with those requirements on the date of authorisation and on an on-going basis[Yes / No / N/A]5.2.9If yes to question 5.2.1(b) above (i.e., the applicant intends to act as an ancillary insurance intermediary), confirm that the applicant has reviewed and assessed the requirements set out in Regulations 30, 31(1)(a), (c), (d) and (i) and 33 to 37 of the IDR, and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with those requirements on the date of authorisation and on an on-going basis[Yes / No / N/A]5.2.10Confirm that the applicant has reviewed and assessed the requirements (applicable to its activities) set out in Regulation 38 of the IDR and Commission Delegated Regulation (EU) 2017/2358 with regard to product oversight and governance requirements for insurance undertaking and insurance distributors, and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with the applicable requirements on the date of authorisation and on an on-going basis[Yes/No]5.2.11Confirm that the applicant’s product distribution arrangements will aim to prevent and mitigate customer detriment, and ensure that the objectives, interests and characteristics of customers are taken into account[Yes/No]5.2.12Confirm that the applicant will regularly review its product distribution arrangements to ensure that those arrangements remain appropriate and up to date[Yes/No]5.2.13If yes to question 5.2.3 above (i.e., the applicant will be undertaking insurance distribution in relation to insurance-based investment products), confirm that the applicant has reviewed and assessed the requirements set out in Regulations 39 to 43 of the IDR, and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with those requirements on the date of authorisation and on an on-going basis[Yes / No / N/A]5.2.14 Premium Handling Requirements (a)Confirm if the applicant intends to operate a Client Premium Account(s)[Yes/No](b)If yes to question 5.2.14(a) above, confirm that the applicant has reviewed and assessed the Premium Handling Requirements set out in the Consumer Protection Code 2012 and the IDR, and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with those requirements on the date of authorisation and on an on-going basis[Yes/No / N/A](c)If yes to question 5.2.14(a) above, identify the authorised signatories on the Client Premium Account(s) [Document Reference](d)If yes to question 5.2.14(a) above, provide a copy of a bank statement showing that a bank account has been opened in the legal name of the applicant and has been specifically designated as a Client Premium Account [Document Reference]5.2.15 Managing General Agents(a)If yes to question 2.3 above (i.e., the applicant proposes to act as a MGA), provide a detailed description of the following:The services that the applicant will provide as an MGA;The level of authority that the applicant will have under the delegated underwriting authority agreement(s) with the insurance undertaking(s) and, in particular, outlining if the applicant will have discretion to operate to its own parameters in terms of risk acceptance, premium pricing etc., or the relevant details where the applicant will only be permitted to operate within parameters set by the insurance undertaking(s).The process for entering into a new delegated underwriting authority agreement(s) with a new insurance undertaking(s) and the criteria to be applied in respect of accepting a new insurance undertaking(s), including the due diligence that the applicant will carry out initially and on an on-going basis in respect of the relevant insurance undertaking(s);Contingency plans and processes in place in the event of an insurance undertaking(s) exiting the market, i.e. process of notification, timelines involved, customer impact assessment and continuity of service etc.; and Whether the applicant will accept risk for any of the insurance products it proposes to distribute[Document Reference](b)If yes to question 2.3 above, provide a copy of the delegated underwriting authority agreement(s) to be put in place with the relevant insurance undertaking(s)[Document Reference](c)If yes to question 2.3 above, provide a comprehensive breakdown of the roles and responsibilities of the relevant parties (i.e., the applicant, the insurance undertaking(s) (s) and any retail broker(s)) in relation to the following processes and setting out what each activity entails (i) Policy Administration (ii) Marketing (iii) Underwriting (iv) Product Development (v) Pricing and (vi) Claims Management (including reserving) [Document Reference](d)If yes to question 2.3 above, describe how the pre-contractual documentation and policy documentation to be issued by the applicant to consumers will demonstrate the following:That all relevant material information is disclosed in full and in a manner that best informs the customer;That the name of the insurance undertaking and its country of incorporation are clearly identified;That all policy and associated documentation provided is clear and transparent with regard to the role of the insurance undertaking in underwriting the policy and the applicant’s role as an MGA; andThat the form, prominence and size of important information does not disguise, diminish or obscure the role of the insurance undertaking in underwriting the policy, or its name and country of incorporation [Document Reference](e)If yes to question 2.3 above, confirm whether the applicant will engage in activities on behalf of the insurance undertaking(s) that do not fall within the scope of the definition of insurance distribution, as defined in Regulation 2 of the IDR[Yes / No](f)If yes to question 5.2.15(e) above, describe the relevant activities and outline how the applicant will ensure that when engaged in activities that do not fall within the scope of the IDR, how a consumer, an insurance undertaking(s) or other entities with which it conducts business will be aware that those activities, which fall outside the scope of the IDR, are not regulated by the Central Bank under the IDR[Document Reference](g)If yes to question 2.3 above, confirm whether the applicant intends to distribute insurance products to customers via other insurance, reinsurance or ancillary insurance intermediaries[Yes / No](i)If yes to question 2.3 above, describe the governance and oversight arrangements in place by the insurance undertaking(s) in respect of the activities to be undertaken by the applicant pursuant to the delegated underwriting authority agreement(s) in place 5.2.16 IDR Wholesale Brokers(a)Confirm if the applicant proposes to act as a Wholesale Broker in relation to its insurance and/or reinsurance distribution activities i.e., to appoint other insurance, reinsurance or ancillary insurance intermediaries intermediaries[Yes / No / N/A](b)If yes to question 5.2.16(a) above, provide an overview of the activities to be conducted by appointed intermediaries and the number of proposed intermediaries to be appointed[Document Reference](c)If yes to question 5.2.16(a) above, confirm that the applicant has assessed and is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place in relation to the appointment and on-going oversight of appointed investment intermediaries [Yes / No / N/A](d)If yes to question 5.2.16(a) above, provide details of the due diligence checks conducted by the applicant prior to the appointment of an intermediary, highlighting the key areas that are assessed and the reasons that what would cause the applicant to reject an application for appointment from a proposed intermediary, and the on-going monitoring the applicant will perform in respect of appointed intermediaries, describing the activities to be conducted[Document Reference]5.3 European Union (Consumer Mortgage Credit Agreements) Regulations 2016 (CMCAR) Application5.3.1If applying for authorisation as a mortgage credit intermediary under the CMCAR , confirm if the applicant intends to engage in the following activities:(a)Presenting or offering mortgage credit agreements to consumers[Yes/No](b)Assisting consumers by undertaking preparatory work or other pre-contractual administration in respect of credit agreements other than as referred to in point (a) above[Yes/No](c)Concluding mortgage credit agreements with consumers on behalf of the creditor[Yes/No](d)Providing advisory services (i.e., the provision of personal recommendations to a consumer in respect of one or more transactions relating to mortgage credit agreements)[Yes/No]5.3.2Confirm that the applicant is not the holder of any of the following licences:(a)Bookmakers Licence[Yes/No](b)Licence for the sale of intoxicating liquor[Yes/No](c)Gaming Licence[Yes/No](d)Moneylender Licence[Yes/No](e)Pawnbroker Licence[Yes/No]5.3.3Provide details of the identity of the undertakings (i.e., creditors and/or mortgage credit intermediaries) in respect of which the applicant intends to act as a mortgage credit intermediary in the first 12 months post authorisation below:Legal NameTrading NamePostal AddressEmail AddressPhone Number[Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer]5.3.4For the undertakings identified in response to question 5.3.3 above, provide at least one Letter of Appointment in place (signed by the applicant and the relevant undertaking, but not yet effective) [Document Reference]5.3.5For each undertaking identified in response to question 5.3.3 above, where a Letter of Appointment is not in place at authorisation date, confirm that the applicant will have a Letter of Appointment in place (signed by the applicant and the relevant undertaking) and an updated Certificate of Authorisation from the Central Bank in place prior to the applicant acting as a mortgage credit intermediary with regard to that undertaking[Yes / No]5.3.6Provide details of the person(s) within the applicant who is (are) responsible for the mortgage credit intermediation business, as provided for in Regulation 31(10)(a) of the CMCAR:Name[Type Answer]Position in the Applicant[Type Answer]Postal Address[Type Answer]Telephone Number[Type Answer]Email Address[Type Answer]5.3.7Confirm that the person(s) proposed in response to question 5.3.6 above will hold a PCF role within the applicant and will be compliant with the requirements of the Minimum Competency Code 2017 as at authorisation date[Yes/No]5.3.8Confirm that the applicant has assessed and is satisfied that the person(s) identified in response to question 5.3.6 above has (have) the appropriate skills and experience to assume this responsibility as provided for in Regulation 10 of the CMCAR[Yes/No]5.3.9 CMCAR Wholesale Brokers(a)Confirm if the applicant proposes to act as a Wholesale Broker in relation to its mortgage credit intermediation activities i.e., to appoint other mortgage credit intermediaries[Yes/No / N/A](b)If yes to question 5.3.9(a) above, provide an overview of the activities to be conducted by appointed intermediaries and the number of proposed intermediaries to be appointed[Document Reference](c)If yes to question 5.3.9(a) above, confirm that the applicant has assessed and is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place in relation to the appointment and on-going oversight of appointed intermediaries(d)If yes to question 5.3.9(a) above, provide details of the due diligence checks conducted by the applicant prior to the appointment of an intermediary, highlighting the key areas that are assessed and the reasons that would cause the applicant to reject an application for appointment from a proposed intermediary, and the on-going monitoring the applicant will perform in respect of appointed intermediaries, describing the activities to be conducted[Document Reference]5.4 Consumer Credit Act 1995 (CCA) Application5.4.1If applying for authorisation as a mortgage intermediary under the CCA, confirm if the applicant intends to engage in the following activities:(a)Introducing consumers to an intermediary who arranges, or offers to arrange, for a mortgage lender to provide the consumer with a housing loan[Yes/No](b)Arranging, or offering to arrange, for a lender to provide equity release credit agreements to consumers [Yes/No]5.4.2Confirm that the applicant is not the holder of any of the following licences:(a)Bookmakers Licence[Yes/No](b)Licence for the sale of intoxicating liquor[Yes/No](c)Gaming Licence[Yes/No](d)Moneylender Licence[Yes/No](e)Pawnbroker Licence[Yes/No]5.4.3Provide details of the identity of the undertakings (i.e., creditors and/or mortgage intermediaries) in respect of which the applicant intends to act as a mortgage intermediary in the first 12 months post authorisation below:Legal NameTrading NamePostal AddressEmail AddressPhone Number[Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer]5.4.4For the undertakings identified in response to question 5.4.3 above, provide at least one Letter of Appointment in place (signed by the applicant and the relevant undertaking, but not yet effective)[Document Reference]5.4.5For each undertaking identified in response to question 5.4.3 above, where a Letter of Appointment is not in place at authorisation date, confirm that the applicant will have a Letter of Appointment in place (signed by the applicant and the relevant undertaking) and an updated Certificate of Authorisation from the Central Bank in place prior to the applicant acting as a mortgage intermediary with regard to that undertaking [Yes/No]5.4.6 CCA Wholesale Brokers(a)Confirm if the applicant proposes to act as a Wholesale Broker in relation to its mortgage intermediation activities i.e., to appoint other mortgage intermediaries[Yes/No / N/A](b)If yes to question 5.4.6(a) above, provide an overview of the activities to be conducted by appointed intermediaries and the number of proposed intermediaries to be appointed[Document Reference](c)If yes to question 5.4.6(a) above, confirm that the applicant has assessed and is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place in relation to the appointment and on-going oversight of appointed intermediaries (d)If yes to question 5.4.6(a) above, provide details of the due diligence checks conducted by the applicant prior to the appointment of an intermediary, highlighting the key areas that are assessed and what would cause the applicant to reject an application for appointment from a proposed intermediary, and the on-going monitoring the applicant will perform in respect of appointed intermediaries, describing the activities to be conducted[Document Reference]PART 6 - Business PlanAll applicants must complete all sections set out below6.1 Business Strategy & Activities6.1.1Provide a detailed Business Plan. This document must contain distinct sections describing each of the following (numbered as per the below):Background and general history: Details of the origin and activities of the applicant;Regulated activities: The applicant’s current (where relevant) and proposed regulated activities under the IIA and/or IDR and/or CMCAR and/or CCA, and regulated activities falling outside the scope of the IIA, IDR, CMCAR and/or CCA regulated by the Central Bank or any other regulatory authority, the duration of the provision of these activities and the income from these activities in the last 12 months;Products / services: The services/products provided and/or proposed;Unregulated activities: An overview of, and background to, the applicant’s unregulated activities, identifying the specific services/products involved in the applicant’s current (where relevant) and proposed unregulated activities, the duration of the provision of these activities where they are currently being provided, the income from these activities in the last 12 months where relevant, a description of the main characteristics and key risks associated with these activities, and a description of the resources and infrastructure (technical or otherwise) in place to support the provision of these activities;Financial status: An overview (supplementary to financial projections referred to below) summarising the applicants financial status with regard to the development of its business;Client base: A brief profile of the proposed client base (including details of their location);Client sourcing: How the applicant intends to source clients (e.g., advertising, personal contacts, engagement with trade bodies, referrals etc.);Business growth: How the applicant intends to grow its business in a manner that ensures that conduct and consumer protection issues do not arise as a result of the applicant’s strategy for growing its client base;Resources: The resources and infrastructure (technical or otherwise) in place to support the provision of the services/products provided/proposed;Third parties & outsourcing: Any third parties involved in the provision of the services/products provided/proposed and their roles and responsibilities; andAgreements: Any referral agreements or other agreements, arrangements, MOUs etc. that the applicant has/proposes to have in place with other parties[Document Reference]6.1.2Confirm whether the applicant considers that, due to the nature of its intended regulated activities, it will be acting as an agent of another entity or it will have other entities acting as its agents[Yes/No]6.1.3If yes to question 6.1.2 above, outline the proposed arrangements in place referring to any agreements in place and the roles and responsibilities of the applicant and any other parties under those agreements[Document Reference]6.1.4Confirm if the applicant proposes to engage in:(a)Any unregulated activities (i.e., activities not falling within the scope of the IIA/IDR/CMCAR/CCA or any other financial services legislation falling within the regulatory remit of the Central Bank or another regulatory authority)[Yes/No](b)Any other regulated activities (i.e., activities not falling within the scope of the IIA/IDR/CMCAR/CCA but within the scope of other financial services legislation falling with the regulatory remit of the Central Bank or another regulatory authority)[Yes/No]6.1.5If yes to questions 6.1.4(a) and/or 6.1.4(b) above, confirm whether the applicant is aware of any potential conflict of interest(s) that may arise in the course of providing its proposed regulated activities[Yes / No / N/A]6.1.6If yes to question 6.1.5 above, confirm that the applicant has assessed and is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant addresses the conflict of interest(s) identified in an appropriate manner[Yes/No]6.2 Client Projections6.2.1(a)Indicate in the table below the total number of existing and future clients of the applicant who meet the definition of a consumer that the applicant anticipates providing services to in each year, by authorisation type, over the next 3 years (include indirect clients where relevant) (include the number of Irish consumers in brackets after the total number):Authorisation DateYear 1Year 2Year 3IIA[Type Answer][Type Answer][Type Answer][Type Answer]IDR[Type Answer][Type Answer][Type Answer][Type Answer]CMCAR[Type Answer][Type Answer][Type Answer][Type Answer]CCA[Type Answer][Type Answer][Type Answer][Type Answer](b)Indicate in the table below how many existing and future clients of the applicant who do not meet the definition of a consumer that the applicant anticipates providing services to in each year, by authorisation type, over the next 3 years: (include indirect clients28 where relevant) (include the number of Irish non-consumers in brackets after the total number):Authorisation Date40Year 1Year 2Year 3IIA[Type Answer][Type Answer][Type Answer][Type Answer]IDR[Type Answer][Type Answer][Type Answer][Type Answer]CMCAR[Type Answer][Type Answer][Type Answer][Type Answer]CCA[Type Answer][Type Answer][Type Answer][Type Answer]6.3 Financial Details 6.3.1Provide the following documents/information:(a)Detailed projected Balance Sheet as at authorisation date (estimate authorisation date as being 6 months after the date of making an application submission)[Document Reference](b)Detailed projected monthly (including 12 month total) Profit and Loss Account for the first year of authorisation (first 3 years for IIA applicants) breaking the income down by service/product (for regulated and unregulated business) and highlighting how the applicant will be in a position to meets its costs as they fall due[Document Reference](c)Detailed projected Balance Sheet as at the end of the first year of authorisation[Document Reference]6.3.2In respect of items 6.3.1(a) to (c) above, confirm that the documents have been accompanied by clear and comprehensive notes explaining each line item, how figures were calculated, and whether particular line items include any sub-items[Yes/No]6.3.3Confirm if there are any charges, guarantees, indemnities or other security or commitments (including Letters of Comfort) given by the applicant to third parties which are in effect at the date of making an application submission or which it is envisaged will be given in the first 12 months after authorisation date (including those relating to other Group undertakings, where relevant) [Yes/No]6.3.4If yes to question 6.3.3 above, provide details [Document Reference]6.3.5Provide details of how the applicant will monitor and mitigate the risk that it may not be able to operate within the bandwidth of its financial projections on an on-going basis[Document Reference]6.3.6Provide details of:Where in the State the applicant’s accounting records will be maintained;The applicant’s accounting year-end; andThe accounting standards the applicant proposes to apply[Document Reference]6.3.7Where the applicant is a corporate entity and/or is seeking authorisation as a retail intermediary under the IIA, confirm that where the applicant is granted an authorisation it will ensure that an annual audit of its financial statements is completed by an auditor as provided for in Section 33 of the IIA and Section 333 of the Companies Act 2014[Yes / No / N/A]6.3.8Where the applicant has been required to prepare audited financial statements, provide a copy of the most recent audited financial statements[Document Reference]6.3.9Where the applicant has previously had its financial statements audited, confirm whether the audited financial statements carried a qualified opinion, adverse opinion or disclaimer of opinion in any of the 5 years preceding the date of making an application submission[Yes /No / N/A]6.3.10If yes to question 6.3.8 above, provide a copy of the relevant audit report(s) and supporting information describing the basis for the qualified opinion[Document Reference]PART 7 - Programme of OperationsAll applicants must complete all sections set out below7.1 Structure / Governance and Staffing Arrangements 7.1.1Confirm whether the applicant is part of a Group structure[Yes/No]7.1.2If yes to question 7.1.1 above:[Document Reference](a)Provide a detailed Group Organisation Chart identifying all Group companies and their activities[Document Reference](b)Confirm that the applicant has reviewed and assessed any Group policies it proposes to apply to its business and that it is satisfied that these policies have been amended as required and are appropriate and suitable for the applicant in the context of its specific legal and regulatory obligations[Yes / No / N/A]7.1.3Identify the total full-time equivalent (FTE) number of staff (excluding executive directors) that will be engaged in all regulated and unregulated activities and the number of FTE staff (excluding executive directors) that will be engaged in the regulated activities in respect of which applicant is seeking authorisation[Document Reference]7.1.4Identify the number of FTE executive directors that will be engaged in all regulated and unregulated activities and the number of FTE executive directors that will be engaged in the regulated activities in respect of which the applicant is seeking authorisation[Document Reference]7.1.5Identify the staff (excluding executive directors) that will comply with the requirements set out in the Minimum Competency Code 2017 (MCC) and identify the specified functions (as outlined in the MCC) that they will be engaged in which requires them to comply with the requirements set out in the MCC[Document Reference]7.1.6Identify the executive directors that will comply with the requirements set out in the MCC and outline the specified functions (as outlined in the MCC) that they will be engaged in which requires them to comply with the requirements set out in the MCC[Document Reference]7.1.7Describe the governance and staff resourcing arrangements in place to ensure that adequate and effective control of the applicant rests in the State (i.e., that the substance and mind and management of the applicant is located in the State and the day-to-day decisions in respect of the applicant’s business are made in the State) and that the applicant is capable of being effectively supervised by the Central Bank[Document Reference]7.1.8Provide a detailed Staff Organisation Chart. This chart should include or be accompanied by the following information:Staffing structure within the applicant, including roles and reporting and communication lines within the applicant;Functional units/departments (e.g. Operations, Finance & Accounting, IT, Compliance, Risk Management, Internal Audit);The location of employees;Any outsourced employees or functions[Document Reference]7.1.9Provide details of any activities carried out by proposed employees and executive directors that are not directly related to the applicant’s business, including details of how the applicant can demonstrate that this will not impact on their ability to fulfil their role in the applicant[Document Reference]7.1.10Describe the frequency, quorum, location and standing agenda for Board of Directors meetings (or other equivalent governance forums for non-corporates)[Document Reference]7.1.11Describe how decisions regarding governance and operational matters are made in the applicant, including details of who makes such decisions[Document Reference]7.1.12Confirm that the applicant will document and maintain appropriate records in respect of key decisions made by the applicant in respect of governance, compliance (including conduct and consumer protection risks), financial and operational matters discussed at Board meetings (or other equivalent governance forums for non-corporates) referred to in question 7.1.10 above)[Yes/No]7.1.13Provide details of the proposed composition of the Board of Directors of the applicant (or other equivalent governance forums for non-corporates):NameRoleLocationTitle (e.g. Executive Director/Independent Non-Executive Director/Non-Executive Director / Partner, Sole Trader, Senior Manager)[Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer]7.1.14List all the individuals proposed to hold ANY PCF roles in the applicant in the table below (see here for the list of PCF roles):NamePCF Number & PCF TitleLocationJob Title[Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer]7.1.15Confirm that the applicant will submit all required IQs (including the Vetting Invitation Form (including proof of identity) and the Vetting Application Form (where relevant)) within 20 working days of receipt of request to submit relevant IQ’s, and that the applicant is aware that its application will not be progressed to the Assessment Phase of the application process if all required IQs (including the Vetting Invitation Form (including proof of identity) and the Vetting Application Form (where relevant)) are not submitted or are deemed not to contain all the key information and documentation required. The Individual identified in response to question 3.10 b) above will be issued login details for the ONR, where required, upon receipt of a fully completed application form from the applicant.7.1.16Confirm whether any director or partner of the applicant has:(a)Resigned from the applicant within the last three years[Yes/No / N/A](b)Not been re-appointed by the applicant within the last three years[Yes / No / N/A](c)Been dismissed from the applicant within the last three years[Yes / No / N/A]7.1.17If yes to question 7.1.16(a), (b) and/or (c) above, provide details of the reasons for the resignation, non-appointment or dismissal, as appropriate[Type Answer]7.1.18Confirm if any person(s) (aside from those identified as PCF role holders in response to question 7.1.14 above) are in a position to exercise a significant influence over the applicant or the management of the applicant 7.1.19If yes to question 7.1.18 above, identify the person(s), their relationship to the applicant and the nature of their influence[Type Answer]7.2 Minimum Competency Code 2017 (MCC) & Minimum Competency Regulations 2017 (MCR)7.2.1Confirm that the applicant has reviewed and assessed the requirements set out in the MCC and MCR (located here) and that it is satisfied that the relevant individual(s) in the applicant falling with the scope of the MCC possess the appropriate level of knowledge and competence as required by the MCC, and that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant and all relevant individuals comply with their obligations under the MCC and MCR on the date of authorisation and an on-going basis[Yes/No]7.2.2Confirm if any person(s) within the applicant will be engaged in providing advice or information to consumers on retail financial products or arranging or offering to arrange retail financial products for consumers, including any amendments to insurance cover [Yes/No]7.2.3If yes to question 7.2.2 above, provide details of their name and role (add rows below as required):Name:Role:Name:Role:7.2.4Confirm if any person(s) within the applicant will be engaged in acting for or on behalf of the applicant in the direct management or supervision of those persons who will act for or on behalf of the applicant in providing advice or information to consumers about retail financial products or who will arrange or offer to arrange retail financial products for consumers or who will carry out one or more specified functions (add rows below as required):[Yes/No]7.2.5If yes to question 7.2.4 above, provide details of their name and role (add rows below as required):Name:Role:Name:Role:7.2.6Identify the person(s) within the applicant who will be responsible for adjudicating on any complaint communicated to the applicant by a consumer which relates to:advice or information about a retail financial product provided to that consumer; orthe arranging or the offering to arrange of a retail financial product for that consumer; orassisting consumers in the making of a claim under contracts of insurance; ordetermining the outcome of claims by consumers arising under contracts of insurance (add rows below as required):Name:Role:Name:Role:7.2.7Identify if any person(s) within the applicant will be engaged in the exercise of any of the following activities:(a)Assisting consumers in the making of a claim under contracts of insurance; and[Yes/No](b)Determining the outcome of claims by consumers arising under contracts of insurance[Yes/No]7.2.8If yes to question 7.2.7(a) or (b) above, identify the relevant individual(s) (add rows below as required): Name:Role:Name:Role:7.2.9Confirm that the person(s) identified in response to questions 7.2.3, 7.2.5, 7.2.6 and, where applicable, 7.2.8, is (are) compliant with the requirements set out in the MCC[Yes/No]7.2.10If no to question 7.2.9 above, provide details of the person(s) that are not compliant with the requirements set out in the MCC and the basis for such non-compliance[Type Answer]7.3 Professional Indemnity Insurance (PII) 7.3.1Confirm that the applicant will provide a copy of its PII policy, associated schedules and evidence of payment of the relevant insurance premium at the Notification of Assessment phase of the application process if requested to do so by the Central Bank. (The applicant may wish to seek a PII quote during the application process to prevent a delay in the granting of an authorisation where the Central Bank’s assessment of the applicant’s application submission is favourable. The applicant should also review the Guidance for Retail Intermediaries on the Requirement to hold Professional Indemnity Insurance Cover)[Yes / No / N/A]7.3.2If the applicant is applying for authorisation under the IDR, confirm that on the date of authorisation the applicant will hold a PII Policy in its own legal name that explicitly:refers to providing cover for insurance distribution activities and/or reinsurance distribution activities (as appropriate) under the IDR; andprovides a per claim limit of cover for insurance distribution activities and/or reinsurance distribution activities (as appropriate) under the IDR of at least €1,300,380; andprovides an aggregate limit of cover for insurance distribution activities and/or reinsurance distribution activities (as appropriate) under the IDR of at least €1,924,560 [Yes / No / N/A]7.3.3If the applicant is applying for authorisation under the IIA, confirm that on the date of authorisation the applicant will hold a PII Policy in its own legal name that explicitly:refers to providing cover for investment advice/investment business services under the IIA; andprovides a per claim limit of cover for investment advice/investment business services of at least €1,300,380; andprovides an aggregate limit of cover for investment advice/investment business services of at least €1,924,560[Yes / No / N/A]7.3.4If the applicant is applying for authorisation under the CMCAR, confirm that on the date of authorisation the applicant will hold a PII Policy in its own legal name that explicitly:refers to providing cover for acting as a mortgage credit intermediary under the CMCAR; andprovides a per claim limit of cover for acting as a mortgage credit intermediary under the CMCAR of at least €460,000; andprovides an aggregate limit of cover for acting as a mortgage credit intermediary under the CMCAR of at least €750,000[Yes / No / N/A]7.3.5Confirm that where the applicant’s PII policy is part of a Group PII policy or includes other entities, that the per claim and aggregate limits referred to in questions 7.3.2 and/or 7.3.3 and/or 7.3.4 above for each authorisation sought are explicitly ring-fenced for the applicant’s PII cover, where aggregate and per claim limits apply[Yes / No / N/A]7.3.6Confirm that the applicant has reviewed and is satisfied that it has the financial resources to cover the excess on its PII policy, and that the applicant’s resources are sufficient to cover multiple PII claims in the policy period[Yes / No / N/A]7.3.7Confirm whether any claims have been made against any PII policy held by the applicant in the last three years or whether the applicant has dealt with any potential claims outside of its PII policy[Yes / No / N/A]7.3.8If yes to questions 7.3.7 above, provide details of the claim(s) below[Type Answer]7.4 Compliance / Internal Audit7.4.1Confirm that the applicant has assessed and is satisfied that it has adequate resources and appropriate governance arrangements and internal systems, controls and procedures in place to monitor its on-going compliance with its legal and regulatory obligations[Yes/No]7.4.2Confirm that the applicant has adequate resources with the appropriate compliance expertise in place to review and assess the applicant’s compliance processes and its compliance with its legal and regulatory obligations[Yes/No]7.4.3Confirm that the applicant has assessed the risks relating to its compliance obligations and that it has established and will implement and maintain an appropriate programme of compliance monitoring activities to ensure that the applicant complies with its legal and regulatory obligations on the date of authorisation and on an on-going basis[Yes/No]7.4.4Provide an overview of the applicant’s Compliance and Internal Audit functions describing the scope of the remit of those functions, the processes in place within those functions for periodic monitoring of the internal systems, controls and procedures in place in the applicant, including the frequency of such monitoring activities and the human resources allocated to conducting these activities, and identifying the individual(s) responsible for overseeing these functions. Provide details of the reporting lines of these functions to the Board of Directors (or other equivalent governance structures for non-corporates) and whether any Board committees have been set up in respect of these areas[Document Reference]7.4.5Provide details of the key risks that will be faced by the applicant, describing the risks and the measures the applicant has in place to monitor and mitigate these risks[Document Reference]Fitness and Probity (F&P Standards)7.4.6Confirm that the applicant has reviewed and assessed the standards set out in the Fitness and Probity Standards (Code issued under Section 50 of the Central Bank Reform Act 2010), and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant and all relevant individuals comply with their obligations under the F&P Standards on the date of authorisation and an on-going basis[Yes/No]Consumer Protection Code 2012 (CPC)7.4.7Confirm that the applicant has reviewed and assessed the requirements set out in the CPC, and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with its obligations under the CPC on the date of authorisation and an on-going basis[Yes/No]7.4.8Confirm that the applicant has reviewed and assessed the requirements set out in the September 2019 Addendum to the CPC in respect of (1) amendments arising from the IDR (effective from 25 September 2019) and (2) enhanced consumer protection measures related to intermediary inducements (effective from 31 March 2020), and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with its obligations under the September 2019 Addendum to the CPC on the date of authorisation and an on-going basis[Yes/No]7.4.9Anti-Money Laundering & Counter Terrorist FinancingIf the applicant is applying for authorisation under the IIA or to provide regulated activities under the IDR relating to Life Assurance Protection Policies (i.e., any product underwritten by a Life Insurance Undertaking), confirm that where relevant, the applicant has reviewed and assessed the requirements of all relevant Anti-Money Laundering and Counter Terrorist Financing legislation, and that it is satisfied that it has appropriate governance arrangements and internal systems, controls and procedures in place to ensure that the applicant complies with any such obligations on the date of authorisation and on an on-going basis [Yes / No / N/A]7.5 Qualifying Shareholders7.5.1List all the direct and indirect shareholders or members with qualifying holdings in the applicant in the table below:Name of ShareholdersNatural or Legal PersonBasis and Number of Shares heldPercentage of Shares held (%)Date AcquiredDirect Shareholders[Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer]Indirect Shareholders[Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer][Type Answer]7.5.2For each legal person with a qualifying holding in the applicant listed in response to question 7.5.1 above, confirm if they are in the process of, or have ever, in any jurisdiction:(a)Been refused, prohibited, restricted or suspended from the right to carry on any trade, business or profession [Yes/No] (b)Been the subject of any complaint to the Central Bank, Financial Services and Pensions Ombudsman or any equivalent body relating to activities regulated by the Central Bank and or regulated by an equivalent body [Yes/No] (c)Been subject to any disciplinary proceedings, issued with a warning, reprimand or other administrative sanction or its equivalent by the Central Bank or an equivalent measure by an equivalent body [Yes/No] (d)Been convicted of an offence, involving money laundering, terrorist financing, fraud, misrepresentation, dishonesty or breach of trust [Yes/No] (e)Had a civil finding, judgement or order made against it in relation to proceedings involving money laundering, terrorist financing, fraud, misrepresentation, dishonesty or breach of trust [Yes/No] (f)Been the subject of any civil penalty enforcement action taken by a regulatory authority under any law[Yes/No] (g)Been untruthful or provided false or misleading information to the Central Bank or been uncooperative in any dealings with the Central Bank or an equivalent body[Yes/No](h)Been refused registration, authorisation, membership, or had its licence revoked, otherwise than on a voluntary basis [Yes/No] (i)Been investigated, disciplined, censured, suspended or criticised by a regulatory or professional body, a court or tribunal or any similar body, whether publicly or privately, in any jurisdiction [Yes/No] (j)Been found by the Central Bank or any an equivalent body to have perpetrated or participated in any negligent, deceitful or otherwise discreditable business or professional practice [Yes/No](k)Defaulted upon any payments due arising from a compromise or scheme of arrangement with creditors or made an assignment for the benefit of creditors[Yes/No](l)Been subject to a judgement debt which is unsatisfied, either in whole or in part [Yes/No](m)Been the subject of a bankruptcy petition in any jurisdiction [Yes/No](n)Been adjudicated a bankrupt and the bankruptcy is undischarged [Yes/No](o)Been the subject of insolvency (i.e. non voluntary liquidation, receivership, examinership or administration)[Yes/No](o)Been convicted of a criminal offence or been subject to criminal investigations and proceedings or civil proceedings [Yes/No](p)Have any criminal proceedings pending relating to them [Yes/No](q)Been subject to any expulsion by an authority or public sector entity in the financial services sector or by a professional body or association[Yes/No](r)Agreed to an out of court settlement in respect of legal proceedings brought against them[Yes/No]7.5.3If yes to ANY of the questions in 7.5.2 (a)–(r) above, provide details below[Type Answer]7.5.4For each natural person with a qualifying holding in the applicant listed in response to question 7.5.1 above (with the exception of natural persons that are proposed to hold a PCF role in the applicant and will submit an IQ), confirm if they are in the process of, or have ever, in any jurisdiction:(a)Been refused, prohibited, restricted or suspended from the right to carry on any trade, business, or profession[Yes/No](b)Been the subject of a complaint to the Central Bank, Financial Services & Pensions Ombudsman, or an equivalent body relating to activities regulated by the Central Bank or regulated by an equivalent authority[Yes/No](c)Been subject to disciplinary proceedings, issued with a warning, reprimand or other administrative sanction or any equivalent measures by the Central Bank or an equivalent measure by an equivalent body[Yes/No](d)Been dismissed or asked to resign and did resign from any profession, vocation, office or employment, or from any position of trust or fiduciary appointment, whether or not remunerated[Yes/No](e)Been a director of a company that was struck off the register of companies by the Irish Companies Registration Office (or equivalent elsewhere), other than on a voluntary basis[Yes/No](f)Been disqualified or restricted from acting as a director or from acting in any managerial capacity[Yes/No](g)Held a position of responsibility or shareholding in a business (or legal entity) where they or that entity has been convicted of an offence, involving money laundering, terrorist financing, fraud, misrepresentation, dishonesty, breach of trust, or an offence which would be relevant to their ability to be considered a suitable shareholder[Yes/No](h)Had a civil finding, judgement or order made against them in relation to proceedings involving money laundering, terrorist financing, fraud, misrepresentation, dishonesty, breach of trust or another matter that could affect their ability to be considered a suitable shareholder[Yes/No](i)Been the subject of any civil penalty enforcement action taken by a regulatory authority under any law[Yes/No](j)Been untruthful or provided false information to the Central Bank or been uncooperative in any dealings with the Central Bank or an equivalent body[Yes/No](k)Been a sole trader or director or a partner of a legal entity that has been refused registration, authorisation, membership, or had its licence revoked, other than on a voluntary basis[Yes/No](l)Been investigated, disciplined, censured, suspended or criticised by a regulatory or professional body, a court or tribunal, or any similar body, whether publicly or privately[Yes/No](m)Held a position of responsibility or shareholding in a business (or legal entity) where you or that entity was or is being investigated, disciplined, censured, suspended, or criticised by a regulatory or professional body, a court or tribunal, or any similar body, whether publicly or privately[Yes/No](n)Been found by the Central Bank or any other equivalent body to have perpetrated or participated in any negligent, deceitful or other discreditable business or professional practice[Yes/No](o)Defaulted upon any payments due arising from a compromise or scheme of arrangement with their creditors, or made an assignment for the benefit of their creditors[Yes/No](p)Been subject to a judgement debt which is unsatisfied, either in whole or in part[Yes/No](q)Been the subject of a bankruptcy petition[Yes/No](r)Been adjudicated a bankrupt and the bankruptcy is undischarged[Yes/No](s)Been the director of an entity which has been the subject of an insolvency (i.e. a non-voluntary liquidation, receivership, or administration)[Yes/No](t)Been convicted of a criminal offence or been subject to criminal investigations and proceedings or civil proceedings[Yes/No](u)Have criminal proceedings pending relating to them or an organisation managed by them[Yes/No](v)Have ever been subject to any expulsion by an authority or public sector entity in the financial services sector or by a professional body or association[Yes/No](w)Agreed to an out of court settlement in respect of legal proceedings brought against them [Yes/No]7.5.5If yes to ANY of the questions in 7.5.4(a)-(w) above, provide details below[Type Answer]7.5.6For each legal and natural person with a qualifying shareholding listed in response to question 7.5.1 above, confirm that at this time, to the best of the applicant’s knowledge and belief, and having conducted appropriate due diligence, that for such persons: (a)The total of their assets exceeds the total of their liabilities[Yes / No / N/A](b)They are able to meet their liabilities as they fall due[Yes / No / N/A](c)The qualifying shareholders are not currently aware of any circumstances that would cause this position to change within the next 12 months[Yes / No / N/A]7.5.7If yes to ANY of the questions in 7.5.6(a)-(c) above, provide details below[Type Answer]7.5.8Confirm if you have any information to disclose regarding any material issue or any concern you have about the suitability of any qualifying shareholder[Yes/No]7.5.9If yes to question 7.5.8 above, provide details below[Document Reference]7.6 Close Links7.6.1Confirm whether any close links exist between the applicant and any natural or legal person(s)[Yes/No]7.6.2If yes to question 7.6.1 above, provide details in respect of the natural/legal person(s) the applicant has close links with, including the location of the relevant entity or person, the nature of the relationship with the natural/legal person(s) and the basis of the close links [Document Reference]7.7 Outsourcing7.7.1Confirm whether the applicant intends to outsource any important operational function(s) to another entity (Group or non-Group)[Yes/No]7.7.2If yes to question 7.7.1 above, provide:A list of each outsourced operational function and a description of each operational function including the name of the outsourced service provider and their location;Details of the rationale for outsourcing each operational function;Details of the programme of oversight and verification to be completed by the applicant to ensure that the outsourced activity is being provided in line with the service levels contractually agreed with the outsourced service provider;Details of the persons within the applicant who are responsible for completing and overseeing the programme of oversight and verification in respect of the outsourced service provider and their location;Confirmation that the applicant has a Service Level Agreement(s) in place (not yet effective) with each outsourced service provider(s) [Document Reference]7.7.3If yes to question 7.7.1 above, confirm that the applicant has assessed and is satisfied that for each important operational function it intends to outsource:(a)It has an appropriate Service Level Agreement (including details of Key Performance Indicators, monitoring and escalation procedures, contingency plans in the event of disruption or discontinuation of services etc.) in place(The Central Bank may request a copy of the relevant Service Level Agreement(s))[Yes/No](b)It has appropriate governance arrangements and internal systems, controls and procedures in place, including an adequate monitoring and reporting programme, in respect of the outsourced operational function to oversee and ensure adherence to the terms of the Service Level Agreement [Yes/No](c)Each relevant Service Level Agreement includes an express provision that the entity providing services to the applicant will provide both the applicant and the Central Bank with access to all books and records and other documents in respect of the activities of the applicant[Yes/No](d)The outsourcing of the operational function will not result in any conflict of interest(s) or a negative impact on clients (particularly those falling within the meaning of vulnerable consumers as defined in the Consumer Protection Code 2012)[Yes/No](e)It will remain fully liable for any acts of the entity to which it has outsourced an operational function [Yes/No](f)The outsourcing of the operational function will not result in the delegation by senior management of the applicant of its responsibility for the outsourced function [Yes/No](g) The relationship and obligations of the applicant towards its clients shall not be altered[Yes/No](h)The conditions (if any) with which the applicant must comply, in order to be authorised as a retail intermediary and remain so, shall not be undermined[Yes/No](i)None of the other conditions (if any) subject to which the applicant’s authorisation is granted shall be removed or modified by the outsourcing arrangement and the applicant will remain fully responsible for the fulfilment of such conditions[Yes/No](j)The outsourcing of the operational function will not be undertaken in such a way as to materially impair the quality of the applicant’s internal controls and the ability of the Central Bank to monitor the applicant’s compliance with all relevant obligations[Yes/No](k)Where the applicant intends to engage in insurance distribution activities in relation to risks and commitments located within the EU/EEA using the insurance distribution services of a third country intermediary, provide a description of how it will comply with Regulation 9(9) of the IDR[Document Reference]7.8 IT Systems, Website and Business Continuity Planning 7.8.1Please provide an overview of the governance arrangements and internal systems, controls and procedures in place in respect of the development and maintenance of the IT systems and website(s) (where relevant) used in the provision of the applicant’s regulated activities and in respect of maintaining the security, confidentiality, integrity and availability of information and data[Document Reference]7.8.2Confirm that the applicant has appropriate procedures in place for:(a)Amending and maintaining the applicant’s IT systems and website (where relevant)[Yes / No / N/A](b)Implementing contingency arrangements in respect of the applicant’s IT systems and website (where relevant) in the event that any relevant third party service provider is not available[Yes / No / N/A](c)Conducting adequate business continuity and disaster recovery testing (including carrying out adequate back-ups of the applicant’s IT systems and website, where relevant)[Yes / No / N/A](d)Safeguarding the security, confidentiality, integrity and availability of information and data[Yes / No / N/A]7.9 Regulatory Background7.9.1Is the applicant or any related entity currently, or has the applicant or any related entity ever been, regulated by the Central Bank or any other regulatory body (in the State or elsewhere)[Yes/No]7.9.2Has the applicant any other application(s) currently being considered by the Central Bank (including any other applications submitted at the same time as this application) [Yes/No]7.9.3Has the applicant or any person associated with the application ever applied for authorisation by the Central Bank or any other regulatory agency (in the State or elsewhere) and had such an application refused [Yes/No]7.9.4Has the applicant or any person associated with the application ever applied for authorisation by the Central Bank or any other regulatory agency (in the State or elsewhere) but decided not to proceed with such an application [Yes/No]7.9.5Is the applicant a member of any professional association or trade body (in the State or elsewhere)[Yes/No]7.9.6Has the applicant or any person associated with the application ever applied for membership of a professional association or trade body and had such an application refused [Yes/No]7.9.7Has the applicant or any person associated with the application at any time in the previous 10 years:[Yes/No](a)Had a receiver or examiner appointed[Yes/No](b)Failed to satisfy a debt adjudged due or a debt in respect of which a judgement has been registered[Yes/No](c)Entered into a scheme of arrangement or composition of its debts with its creditors[Yes/No]Note: The appointments mentioned in questions 7.9.7(a)-(c) above include any similar appointments made under the laws of another country.7.9.8Has the applicant or any person associated with the application, at any time, been refused or had withdrawn any licence, registration or authorisation by the Central Bank or any other regulatory agency (in the State or elsewhere) [Yes/No]7.9.9Has the applicant or any person associated with the application ever been subject to any disciplinary measures by any regulatory body of which it is, or was, a member[Yes/No]7.9.10Has the applicant changed its (a) legal advisers (b) bankers or (c) auditors in the last three years[Yes/No]7.9.11Have any legal proceedings or administrative sanction proceedings been brought, in the State or any other jurisdiction, against the applicant or any person associated with the application, in which the applicant has either been convicted or found liable, in relation to the provision of financial services [Yes/No]7.9.12Has the applicant or any person associated with the application agreed to an out of court settlement in respect of legal proceedings brought against it [Yes/No]7.9.13Is the applicant or any person associated with the application currently involved in any proceedings of the type described in questions 7.9.11 and 7.9.12 above [Yes/No]7.9.14Have the books, records or other documents of the applicant or any person associated with the application ever been requisitioned or seized by any regulatory body in exercise of its powers, either in the State or in any jurisdiction [Yes/No]7.9.15Has there been any period in the applicant’s history when it was dormant or engaged in other activities [Yes/No]7.9.16Has the applicant not complied with any of its filing requirements with Irish Companies Registration Office [Yes/No]7.9.17If yes to ANY of the questions in 7.9.1 – 7.9.16 above, provide details below[Type Answer]7.9.18Has the applicant and (in so far as the applicant is aware) its PCF role holders, qualifying shareholders, subsidiaries, related undertakings, associated undertakings or employees:(a)Had a petition for the compulsory winding-up, an application for a dissolution order or a bankruptcy petition served at any time in the last 10 years or is such a petition pending [Yes/No](b)Been the subject of a sanction/fine/reprimand by the Central Bank or any other regulatory agency (in the State or elsewhere) [Yes/No](c)Become aware of any tax compliance issues that any of its qualifying shareholders or any of its PCF role holders may have [Yes/No](d)Had any allegations of fraud, dishonesty, breach of trust, insider dealing or market manipulation made against them [Yes/No](e)Had any authorisation/licence to carry on investment, banking or insurance business, in the State or elsewhere, revoked [Yes/No](f)Ever been convicted of any offence involving fraud, dishonesty, breach of trust, insider dealing or under legislation (in the State or elsewhere) relating to companies, building societies, credit unions, friendly societies, insurance, banking or other financial service, insolvency, consumer credit or consumer protection [Yes/No]7.9.19If yes to ANY of the questions in 7.9.18(a)-(f) above, provide details below[Type Answer]7.10 Online Annual Return and Industry Funding Levy 7.10.1Confirm whether the applicant has ever been authorised by the Central Bank or whether any person associated with the application was previously a Director or Sole Trader or Partner or PCF role holder in an entity authorised by the Central Bank[Yes/No]If yes to question 7.10.1 above, confirm that:7.10.2All relevant contributions due under the Industry Funding Levy were discharged in full by the relevant entity during the period in which the Director or Sole Trader or Partner or PCF role holder held such a role with the entity[Ye s/ No / N/A]7.10.3All ONR Returns were up to date and submitted as required by the relevant entity during the period in which the Director or Sole Trader or Partner or PCF role holder held such a role with the entity[Yes / No/ N/A]7.10.4Confirm that the applicant is aware that if it is granted an authorisation under the IIA, IDR, CMCAR and/or CCA by the Central Bank it will be legally obliged to make an annual contribution to the Industry Funding LevyFurther details in respect of the Industry Funding Levy can be found at centralbank.ie/regulation/how-we-regulate/fees-levies/industry-funding-levy[Yes/No]7.10.5Confirm that the applicant will submit an online annual return to the Central Bank via the ONR within six months of the applicant’s year-end if it is granted an authorisation[Yes/No]7.11 Investor Compensation Company DAC (ICCL)7.11.1Where the applicant has answered yes to questions 2.1(a) and/or 5.2.1(a) above and is thus seeking authorisation under the IIA and/or authorisation as an insurance intermediary under the IDR, confirm that the applicant is aware that if it is granted the relevant authorisation it will be legally obliged under the Investor Compensation Act 1998 to make an annual contribution to the Investor Compensation Scheme Details of this scheme can be found at investorcompensation.ie[Yes/No/ N/A]7.11.2Confirm whether the applicant has ever been authorised by the Central Bank or whether any person associated with the application was previously a Director or Sole Trader or Partner or PCF role holder in an entity authorised by the Central Bank[Yes/No]7.11.3If yes to question 7.11.2 above, confirm that all required contributions that were due under the Investor Compensation Scheme were discharged in full by the relevant entity during the period in which the Director or Sole Trader or Partner or PCF role holder held such a role with the entity[Yes / No / N/A]7.11.4Where the applicant has answered yes to questions 2.1(a) and/or 5.2.1(a) above, confirm that the applicant agrees with the following statements:(a)The Central Bank will provide the applicant’s industry correspondence details (including email address(es) and authorisation status to the ICCL in order to allow the ICCL fulfil its statutory obligations and objectives[Yes / No / N/A](b)The Central Bank may obtain information from the ICCL in respect of the applicant’s annual contribution and participation in the Investor Compensation Scheme including information in respect of non-payment of contributions[Yes / No / N/A]7.12 Passporting7.12.1Confirm whether the applicant proposes to provide insurance distribution and/or reinsurance distribution services from a branch established in another Member State (i.e., on a Freedom of Establishment basis)[Yes/No]7.12.2Confirm whether the applicant proposes to provide mortgage credit intermediation from a branch established in another Member State (i.e., on a Freedom of Establishment basis)[Yes/No]7.12.3If yes to question 7.12.1 and/or 7.12.2 above, provide an overview of the proposed activities to be undertaken by each branch, the proposed products to be offered and the relevant client base [Document Reference]7.12.4If yes to question 7.12.1 and/or 7.12.2 above:(a)Confirm that an IQ has been completed and submitted to the Central Bank via the ONR by the applicant in respect of each individual proposed for the role of Branch Manager (PCF 16) in a branch established in another Member State[Yes / No / N/A](b)Describe the staffing arrangements in respect of each branch and the governance arrangements, internal systems, controls and procedures in place to oversee the activities of each branch to ensure that the applicant complies with any local host Member State requirements on the date it commences operation in the host Member State and on an on-going basis. Identify who completes these activities and the frequency of their completion.[Document Reference](c)Confirm that relevant branch staff engaging in activities that fall within the scope of local competency requirements in the host Member State are compliant with the requirements set out in the MCC and any equivalent applicable competency requirements in the host Member State[Yes/No]7.12.5If yes to question 7.12.1 above, confirm that the applicant has submitted the following document(s) with the Application Form:IDR Freedom of Establishment Form (a separate form must be provided for each relevant Member State ) [Yes / No / N/A]7.12.6If yes to question 7.12.2 above, confirm that the applicant has submitted the following document(s) with the Application Form:CMCAR Freedom of Establishment Form (a separate form must be provided for each relevant Member State ) [Yes / No / N/A]7.12.7Confirm whether the applicant proposes to provide insurance distribution and/or reinsurance distribution services on a cross border basis in another Member State (i.e., on a Freedom of Services basis) [Yes/No]7.12.8Confirm whether the applicant proposes to provide mortgage credit intermediation services on a cross border basis in another Member State (i.e., on a Freedom of Services basis) [Yes/No]7.12.9If yes to question 7.12.7 and/or 7.12.8 above, provide an overview of the proposed activities to be undertaken, the products to be offered and the relevant client base[Document Reference]7.12.10If yes to question 7.12.7 and/or 7.12.8 above:(a)Describe the governance arrangements, internal systems, controls and procedures in place to oversee the activities provided on a cross border basis in another Member State(s) to ensure that the applicant complies with any local host Member State requirements on the date it commences operation in the host Member State and on an on-going basis. Identify who completes these activities and the frequency of their completion.[Document Reference]7.12.11If yes to question 7.12.7 above, confirm that the applicant has submitted the following document with the application form:IDR Freedom of Services Form (all relevant Member States should be included on one form)[Yes / No / N/A]7.12.12If yes to question 7.12.8 above, confirm that the applicant has submitted the following document with the application form:CMCAR Freedom of Services Form (all relevant Member States should be included on one form)[Yes / No / N/A]PART 8 - DeclarationAll Applicants must complete the Declaration set out belowSelect ‘Yes’/’No’, as appropriate, in the table below to confirm the legislation under which the applicant is seeking authorisation. Where brackets ([ ]) are included below, amend the text therein, as appropriate. The declaration below must be signed by the sole trader in the case of a sole trader applicant, by two directors in the case of a company applicant (or by the sole director in the case of a single director company applicant), and by two partners in the case of a partnership applicant. A tied mortgage credit intermediary applicant must have a representative of both the creditor and the tied mortgage credit intermediary applicant sign the declaration below. Where the creditor or tied mortgage credit intermediary is a sole trader the declaration must be signed by the sole trader, where the creditor or tied mortgage credit intermediary is a company the declaration must be signed by a director and where the creditor or tied mortgage credit intermediary is a partnership the declaration must be signed by a partner. Legislation under which the applicant is seeking authorisationYes/NoInvestment Intermediaries Act 1995 [Yes/No]European Union (Insurance Distribution) Regulations 2018[Yes/No]European Union (Consumer Mortgage Credit Agreements) Regulations 2016 [Yes/No]Consumer Credit Act 1995[Yes/No][Insert Applicant’s legal name] applies for authorisation under the above legislation on the basis of the information provided with this Application Form, and any additional information provided to the Central Bank in the course of the application process.[I/We] acknowledge that the Central Bank may disclose information in the performance of its statutory functions or otherwise as may be specifically authorised by law.[I/We] warrant that [I/We] have truthfully and fully answered the relevant questions in this Application Form and disclosed any other information which might reasonably be considered relevant for the purpose of this application form.[I/We] warrant that the structure/content of this Application Form has not been altered or amended in any manner (other than to complete responses and/or add additional rows to complete responses to the questions set out in this application form).[I am/We are] aware that it may be an offence and/or grounds for refusal of my application and/or grounds for revocation of an authorisation granted on foot of this application and/or grounds for the Central Bank to commence an Administrative Sanctions Procedure against both [myself/ourselves] and/or the proposing entity for me/us to knowingly or recklessly:Provide false or misleading information and/or to make a false or misleading statement (which it is acknowledged may include the withholding of relevant information) in this application form;Fail to inform and/or withhold from the Central Bank details of any material change in circumstances/new information which is relevant and/or material to this application form.[I/We] warrant that [I/We] will promptly notify the Central Bank of any changes in the information [I/We] have provided and supply any other relevant information which may come to light in the period during which this application form is being considered and, this application is approved, thereafter.[I/We] warrant that [I/We] are authorised to submit this application form seeking authorisation under the above legislation.Signed: _______________________ Position: _____________________Entity: _____________________PRINT NAME: _________________________Signed: _______________________ Position: _____________________Entity: _____________________PRINT NAME: _________________________For and on behalf of [Insert Applicant’s legal name]Dated: [DD / MM / YYYY] NOTE THAT:Section 10(16) of the Investment Intermediaries Act 1995 (IIA) provides that “it shall be an offence for a proposed investment business firm or any other person to apply for authorisation under this section knowingly or recklessly using false or misleading information, or knowingly or recklessly making false or misleading statements, in relation to an application for an authorisation under this section”.Regulation 13(2)(b) of the European Union (Insurance Distribution) Regulations 2018 (IDR) provides that the Central Bank “may withdraw the registration of, and remove from the Register, an insurance, reinsurance or ancillary insurance intermediary where the registration was obtained by means of a false or misleading representation”.Regulation 30(12) of the European Union (Consumer Mortgage Credit Agreements) Regulations 2016 (CMCAR) provides that “a person shall not wilfully give any information which is false or misleading in respect of an application for an authorisation; a person who contravenes this paragraph or any other provision of this Regulation commits an offence”. Section 116(6) of the Consumer Credit Act 1995 (CCA) provides that “a person shall not wilfully give any information which is false or misleading in respect of an application for an authorisation”. All the information requested in this Application Form is required for the assessment of the application and will be treated by the Central Bank in accordance with the professional secrecy obligations set out in Section 33AK of the Central Bank Act 1942 (as amended), without prejudice to applicable EU law and national requirements and procedures on the exercise of the right to access, rectify, cancel or oppose. ................
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